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General NPI Number Information
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NPI Number | 1932340296
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Entity Type | Individual
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Provider Name | DENITRA COLE
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Gender | Female
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Dates
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Enumeration Date | 03/17/2009
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Last Update Date | 03/17/2009
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Provider Practice Location Address
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Address Line | 1455 N LAKELAND DR
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City | MERIDIAN
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State | MS
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Zip | 39307-9020
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Country | US
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Telephone | 601-581-0120
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Fax |
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Provider Business Mailing Address
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Address Line | 729 ALAMUTCHA ST APT B
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City | MARION
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State | MS
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Zip | 39342-9718
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | TA2217
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License Number State | MS
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